Perioral dermatitis
What is perioral dermatitis?
Perioral dermatitis is red bumps or small pimples that usually appear around the mouth, and sometimes around the nose or eyes (also called periorificial dermatitis).
We don’t know exactly why it develops. Sometimes the cause is never clear. However, common triggers include:
Use of steroid creams on the face
Inhaled or nasal steroid sprays (used for asthma or allergies)
Toothpaste containing fluoride
Hormonal changes (such as pregnancy or starting/stopping birth control pills)
Perioral dermatitis is different from acne or rosacea, but treatments can overlap.
How do I treat perioral dermatitis?
Most people with perioral dermatitis need a topical antibacterial cream or wash. These treatments usually take at least 3 weeks of consistent daily use before improvement is seen. While waiting for results, you can use Clinique’s Redness Solutions base to cover redness.
Helpful treatment options include:
Azelaic acid – safe in pregnancy and can be combined with niacinamide.
Sulfur – an excellent anti-inflammatory for redness. Available as a bar soap (wash), gel, or mask in 3%–10% strength. The smell is often masked and does not linger. (See sulfur wash instructions below)
Benzoyl peroxide – effective and widely available (see instructions below). Lower strengths (<5%) work as well as stronger ones without excess dryness. Recommended washes:
CeraVe Acne Foaming Cream Cleanser (4% benzoyl peroxide)
Adapalene gel (Differin, Effaclar, AcneFree, ProActiv) – now available over-the-counter, used at bedtime. See instructions below.
Moisturize: After using any medicated wash or cream, apply a generous layer of CeraVe moisturizing cream at least twice daily to prevent dryness and irritation.
Steps for using a medicated wash:
In the shower, rinse your face (and chest/back if you have acne there).
Apply the sulfur wash or benzoyl peroxide wash and leave it on for 5–10 minutes so the medication can soak in before rinsing.
Use sulfur wash or benzoyl peroxide wash once or twice daily. You do not need another face wash. Avoid exfoliating scrubs.
Notes:
Benzoyl peroxide can cause dryness. Apply plenty of moisturizer until your skin adjusts and acne improves (usually after a few weeks).
Benzoyl peroxide can bleach towels and clothing.
How to Use Adapalene at Bedtime
Start with clean, dry skin.
Dab a pea-sized amount of adapalene gel on the forehead, sides of the face, and chin (outer areas of face).
Rub it in gently.
Use whatever is left on your fingers to lightly spread around the nose, cheeks, and lips (these spots are more sensitive).
💡 Note: This will make your skin dry and flaky at first. That’s normal—it happens to everyone. Your skin will adjust after a few weeks.
🚫 Warning: Don’t use adapalene if you’re pregnant or trying to become pregnant. It may harm a developing baby.
After Adapalene: Moisturize
Right after applying adapalene, use lots of moisturizing cream or ointment. My favorites are CeraVe Cream, Vanicream Cream, or Vaseline (#SlugLife)
Put on a thick layer and go to bed a little shiny—your skin will soak it in overnight.
🕒 Stick with adapalene for at least 30 days—it takes about a month to start seeing results.
My face is peeling with adapalene. What do I do?
Peeling is very common when starting adapalene. Most people think their skin is “too sensitive,” but often the problem is how it's being used—not that it’s the wrong product.
Adapalene dries out your skin before it helps it. The first month is tough—but stick with it! It takes about 30 days for your skin to grow from the bottom up, and that’s when you’ll start seeing real results. It will work! Trust the process!
Tips to reduce peeling and redness from adapalene:
Use the right amount: Only a pea-sized amount is needed for your whole face.
Start on the outside of your face: Apply to the forehead, cheeks, jawline, and chin first. Use what’s left on the nose and near the lips—these areas are more sensitive.
Moisturize a lot: You can’t over-moisturize. Use CeraVe, Vanicream, or Vaseline—especially at night.
Stick with it: Use it every night for one month to see benefits. If nightly use is too much, try every other night—just stay consistent.
Try the “sandwich method”—Put on a thin layer of moisturizer, then adapalene, then a thick layer of moisturizer on top. This helps reduce peeling while still giving you the benefits.
What if my perioral dermatitis isn’t getting better?
Most people improve with the steps above, but sometimes prescription creams or pills are needed. If over-the-counter options are not working, look for a board-certified dermatologist in your area. If you are in or near Utah, see one of my excellent colleagues at the University of Utah or me virtually with Honeydew.
DISCLAIMER
The statements expressed and content of this website are not intended to be a substitute for professional medical advice. Readers should seek their own professional counsel for any medical condition or before starting or altering any treatment, exercise, or dietary plan. Please see our full disclaimer here.